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A comparison of international clinical practice guidelines on adult chronic rhinosinusitis shows considerable variability of recommendations for diagnosis and treatment

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objectives

To compare international clinical practice guidelines on adult chronic rhinosinusitis (CRS).

Design

Extensive literature search in Embase, PubMed and the internet (Google, websites of well-known guideline organizations) on November 21st 2018.

Main outcome measures

Guidelines’ quality was measured by the AGREE II instrument. A summary and comparison of recommendations on diagnosis and treatment with harmonized levels of evidence (LoE) and grade of recommendations (GoR) is given.

Results

We selected ten guidelines on CRS. Five guidelines were of sufficient to high quality according to AGREE II, the remaining guidelines predominantly did not meet AGREE II criteria. We harmonized all guideline recommendations so we could compare them, although three guidelines did not provide a LoE. Five guidelines provided recommendations on diagnosis, all of them recommended performing nasal endoscopy, CT scan and allergy testing (with varying GoRs). All ten guidelines provided recommendations on therapy, one treatment, i.e., the use of intranasal steroids, was recommended by all guidelines (with varying GoRs). Recommendations for surgical treatment of CRS were provided by five guidelines.

Conclusion

We performed an extensive search and included ten (inter)national guidelines on CRS for adults. According to AGREE II, five were of good or sufficient quality. Overall, there was much variation between guidelines in recommended diagnostic test or treatment, direction of evidence and GoR. We found consensus for nasal endoscopy, CT scan, allergy testing and intranasal steroids. We argue for standardization of guideline development, to increase their quality and improve comparability.

Key points

  1. 1.

    With an extensive literature search we found 10 clinical practice guidelines (CPG) on diagnosis and treatment of adult CRS.

  2. 2.

    According to AGREE II, 5 had sufficient to high quality.

  3. 3.

    Overall, there was much variation between CPGs; in entry question (diagnostic test or type of treatment), in direction of evidence (advised to use/not to use) and grade of recommendation (weak, moderate, strong).

  4. 4.

    There was consensus for nasal endoscopy, CT scan, allergy testing and the use of intranasal steroids.

  5. 5.

    To improve CPG quality, we recommend standardization of CPG development, according to AGREE II and GRADE.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

Concept of study design: NK, GH, MA; data acquisition: NK, SC; data analysis/interpretation: NK, GH, SC, MA; drafting manuscript: NK, SC; critical revision of manuscript: NK, GH, SC, RS, MA; final approval: NK, GH, SC, RS, MA.

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 85500, 3508 GA, Utrecht, The Netherlands

    N. M. Kaper & R. J. Stokroos

  2. Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands

    G. J. M. G. van der Heijden

  3. Department of Pulmonology, Haaglanden Medical Centre, Westeinde Hospital, The Hague, The Netherlands

    S. H. Cuijpers

  4. Department of Otorhinolaryngology, Jeroen Bosch Hospital, s’ Hertogenbosch, The Netherlands

    M. C. J. Aarts

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  1. N. M. Kaper
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Correspondence to N. M. Kaper.

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Kaper, N.M., van der Heijden, G.J.M.G., Cuijpers, S.H. et al. A comparison of international clinical practice guidelines on adult chronic rhinosinusitis shows considerable variability of recommendations for diagnosis and treatment. Eur Arch Otorhinolaryngol 277, 659–668 (2020). https://doi.org/10.1007/s00405-019-05752-7

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  • DOI: https://doi.org/10.1007/s00405-019-05752-7

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